Negative CLO test pellets can be reused repeatedly in diagnostic endoscopy within a short period ... more Negative CLO test pellets can be reused repeatedly in diagnostic endoscopy within a short period of time. However, the duration that these pellets can be stored at room temperature before second use remains unclear. A total of 360 patients, 190 males and 170 females, who required a CLO test during endoscopy, were enrolled in this study. Two biopsies were taken from the gastric antrum of each patient, one for testing with a new pellet and the other for testing with a reused pellet. The reused pellets were used randomly and were divided into five groups according to the time interval between their initial and second usages (1, 2, 3, 6, and > 6 mo). When a positive result was found, the time to color change was recorded. Good correlation was noted for nearly all the paired CLO tests in all groups with either both positive or both negative. Only four pairs produced discrepant results. There was no significant difference when the results of both new and reused CLO tests were compared using McNemar's test (p > 0.05). In positive pairs, there was no significant difference in the color change time of both tests in all five groups by two-tailed t-test (p > 0.05); Pearson's correlation and linear regression showed a strong correlation between the color time change in the five groups (p < 0.0001). Only 54 of the 427 negative pellets stored for more than 6 months could be reused because most were dried out or no longer yellow in color. In conclusion, negative CLO test pellets may be reused within 6 months after initial usage provided they are stored at room temperature.
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors arising from the wall of the GI tr... more Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors arising from the wall of the GI tract. They are most common in the stomach (about 70%), 20%~ 30% in the small intestine, and fewer than 10% in other locations of the GI tract [1]. Patients with a GIST ...
Background: Primary esophageal motility disorder, which can cause chest pain or dysphagia, is sel... more Background: Primary esophageal motility disorder, which can cause chest pain or dysphagia, is seldom reported in Chinese. With the introduction of an easy and less uncomfortable method to perform esophageal manometry by low-compliance perfusion system, we studied symptomatic patients for more than 10 years. These data were analyzed and were compared to Western reports. Methods: From August 1989 to June 1999, 264 patients with symptoms mimicking esophageal origin, such as chest pain, dysphagia or odynophagia, but without secondary motility disorders were enrolled. Esophageal manometry was performed on each patient. Results: Among 264 manometric tracings, 142 (54%) were normal and 122 (46%) were abnormal. In patients with abnormal tracings, 73 were nonspecific esophageal motility disorder (NEMD), 20 were achalasia, 9 were diffuse esophageal spasm (DES), 8 were nutcracker esophagus, 7 were hypotensive low esophageal sphincter (LES), 3 were abnormal provocative test by edrophonium, and 2 were hypertensive LES. As in Western countries, the most common abnormality was NEMD. However, our series did not find many patients with DES, nutcracker esophagus and hypertensive LES. Similar results were noted in patients with NEMD, that most had increased nontransmitted contractions and low contraction amplitude. Conclusions: We found that primary esophageal motility disorder is not uncommon in Taiwan. Esophageal manometry should always be considered in patients with symptoms mimicking esophageal origin.
Background: Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer d... more Background: Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer disease. This prospective study was carried out to investigate the relationship between the degree of bulbar deformity and the density of Helicobacter pylori infection in patients with duodenal ulcer. Methods: Patients with endoscopically proven active duodenal ulcers and a positive diagnosis of H. pylori infection were enrolled. Duodenal ulcers were divided into three types according to the degree of deformity of the bulb: type I, normal bulb; type II, mildly deformed; type III, markedly deformed. In each case, we evaluated the H. pylori density histologically. The density was graded according to the Sydney system (normal, mild, moderate, and marked). Results: A total of 95 duodenal ulcer patients were studied, including 25 with type I, 40 with type II, and 30 with type III duodenal ulcers. H. pylori density was correlated with deformity of the duodenal bulb: 16/25 (64%) patients with a type I ulcer had mild infection, 19/40 (47.5%) patients with a type II ulcer had moderate infection, and 15/30 (50%) patients with a type III ulcer had marked infection. Conclusion: Patients with active type II or III duodenal ulcers had greater densities of H. pylori than did those with type I ulcers. A tendency for higher H. pylori density was seen as the degree of deformity of the duodenal bulb increased.
Background and purpose: Many reports have confirmed that endoscopic ultrasonography (EUS) can dif... more Background and purpose: Many reports have confirmed that endoscopic ultrasonography (EUS) can differentiate gastric submucosal tumor from extragastric compression, but only a few specifically concentrated on EUS in identifying the causes of external compression. Materials and methods: From May 1993 to May 2001, we used EUS in 238 patients to diagnose gastric submucosal tumor or external compression. We excluded 183 patients who had submucosal tumors and analyzed the remaining 55 patients with extragastric compression. Malignant causes of external compression were proved by surgery or biopsy. Benign causes of external compression were proved by other imaging examinations (abdominal ultrasound, computerized tomography, angiography) or surgery. Patients with external compression caused by normal organs were followed up with repeated upper gastrointestinal endoscopy or EUS. Results: The stomach was compressed by normal extragastric organs in 32 patients (spleen 10, splenic vessel 6, gall bladder 9, liver 3, pancreas 3, and intestine 1), by benign pathologic lesions in 12 patients (liver cyst 7, liver hemagioma 2, splenic cyst 1, pancreatic cyst 1, pancreatic cystadenoma 1) and by malignant tumors in 5 patients (hepatoma 1, liver metastasis from colon cancer 2, pancreatic cystadenocarcinoma 1 and lymphoma of spleen 1). In the remaining six patients, neither submucosal tumor nor external compression was found during EUS examination and the external compression was considered transient. Conclusion: When an extragastric compression mimicking submucosal tumor is detected by upper gastrointestinal endoscopy, EUS is indicated to identify the cause of extragastric compression.
Colorectal cancer (CRC) is considered to develop slowly via a progressive accumulation of genetic... more Colorectal cancer (CRC) is considered to develop slowly via a progressive accumulation of genetic mutations. Markers of CRC may serve to provide the basis for decision-making, and may assist in cancer prevention, detection and prognostic prediction. DNA and messenger (m)RNA molecules that are present in human feces faithfully represent CRC manifestations. In the present study, exogenous mouse cells verified the feasibility of total fecal RNA as a marker of CRC. Furthermore, five significant genes encoding solute carrier family 15, member 4 (SLC15A4), cluster of differentiation (CD)44, 3-oxoacid CoA-transferase 1 (OXCT1), placenta-specific 8 (PLAC8) and growth arrest-specific 2 (GAS2), which are differentially expressed in the feces of CRC patients, were verified in different CRC cell lines using quantitative polymerase chain reaction. The present study demonstrated that the mRNA level of SLC15A4 was increased in the majority of CRC cell lines evaluated (SW1116, LS123, Caco-2 and T84). An increased level of CD44 mRNA was only detected in an early-stage CRC cell line, SW1116, whereas OXCT1 was expressed at higher levels in the metastatic CRC cell line CC-M3. In addition, two genes, PLAC8 and GAS2, were highly expressed in the recurrent CRC cell line SW620. Genes identified in the feces of CRC patients differed according to their clinical characteristics, and this differential expression was also detected in the corresponding CRC cell lines. In conclusion, feces represent a good marker of CRC and can be interpreted through the appropriate CRC cell lines.
Ascitic infection is a major cause of morbidity and mortality in liver cirrhosis patients. Many r... more Ascitic infection is a major cause of morbidity and mortality in liver cirrhosis patients. Many reports suggest that at least 5 days of third generation cephalosporin is better than a conventional first generation cephalosporin or amoxicillin plus an aminoglycoside for treating ascitic infections. We retrospectively reviewed 54 patients with culture-negative neutrocytic ascites (CNNA) or spontaneous bacterial peritonitis (SBP) who were treated with an intravenous first generation cephalosporin plus short-term gentamicin, or a second or third generation cephalosporin. Thirteen patients with CNNA (group A) were treated with an intravenous first generation cephalosporin plus short-term gentamicin intravenous drip (regimen Ⅰ). Another 18 CNNA patients (group B) were treated with an intravenous second or third generation cephalosporin monotherapy (regimen Ⅱ). Seven patients with SBP (group C) were treated with regimen Ⅰ and 16 patients with SBP (group D) were treated with regimen Ⅱ. Three and 16 patients with shock on admission were treated with regimen Ⅰ or Ⅱ respectively. We compared the success rates of these two regimens in CNNA and SBP groups. The successful treatment rates were 92.3% (12/13), 67.7% (12/18), 57.1% (4/7) and 37.5% (6/16) for groups A, B, C, D, respectively. The difference in success rates between regimen Ⅰ and regimen Ⅱ in the CNNA group or SBP group was not statistically significantly. However, the success rates for antibiotics given to non-septic shock patients and septic shock patients were significantly different (non-septic shock: 32/35 vs. septic shock: 2/19, p＜0.05,) A first generation cephalosporin plus short-term gentamicin has good effect to treat CNNA patients not in shock. But it should be used cautiously to prevent acute renal failure in cirrhosis patients. Broader spectrum antibiotics should be used in patients with shock or any clinical deterioration.
Unexplained chest pain nowadays has become the leading reason for patients being referred for eso... more Unexplained chest pain nowadays has become the leading reason for patients being referred for esophageal manometry. Some drugs are recently used as provocative agents to increase the diagnostic rate during this test and edrophonium chloride is the most common among them. Nevertheless, this provocative test has seldom been applied in Chinese patients. Therefore, we studied 158 consecutive patients with chest pain (group A) and 53 patients with other esophageal symptoms (group B) by using edrophonium as a provocative agent for inducing esophageal chest pain. Each of these patients received 80 μg/kg intravenous bolus dose of edrophonium preceded by saline infusions. Esophageal contractile pressures and contractile duration of upper middle and lower portions were measured before and after drug injection in response to ten 5 mL wet swallows. We found that chest pain was reproduced in only 8 patients and they were all in the group A. Besides, edrophonium increased esophageal pressure signficantly in all three monitored portions of esophageal body but increased contractile duration only in the middle and distal portions. We also found the adverse effects of this agent in such dose were mild and tolerable. In conclusion, edrophonium is relativly safe as a provocative agent and can diagnose chest pain of esophageal origin in small population of Chinese patients.
Objectives: Gastroesophageal flap valve (GEFV) can be divided into a four-grade system and this s... more Objectives: Gastroesophageal flap valve (GEFV) can be divided into a four-grade system and this system can well predict the prevalence of gastroesophageal reflux disease (GERD). We tried to use this GEFV grading system to examine the correlation of GEFV to erosive esophagitis. Methods: We enrolled 398 individuals that underwent one-day self-paid health examination, including esoph agogastroduodenoscopy (EGD) in 3-month period. GEFV grade I and Ⅱ were considered normal, whereas grade Ⅲ and Ⅳ were abnormal. We compared and analyzed the correlation of sex, body mass index (BMI) and GEFV grading with erosive esophagitis. Results: There were 37 subjects being diagnosed as abnormal gastroesophageal flap valve (37/398, 9.3%). 18 of them (18/37, 48.6%) had erosive esophagitis also. The remaining 361 subjects were diagnosed as normal flap valve (361/398, 90.7%) and 53 subjects were diagnosed as erosive esophagitis (53/361, 14.7%). Abnormal gastroesophageal flap valve subjects had higher chance to had erosive esophagitis (Odds Ratio=7.51, 95% CI=3.53-15.98). Males had higher prevalence of erosive esophagitis (Odds Ratio=3.74, 95% CI=1.90-7.38) and the prevalence of erosive esophagitis was 17.8%. Age and BMI did not increase the risk of esophagitis remarkably in the initial analyses (P=0.15 and 0.2) Conclusion: Male gender and subject, who have abnormal gastroesophageal flap valve, are prone to develop erosive esophagitis. Age and BMI do not increase the risk of esophagitis remarkably.
dure can decrease the risks of patient's morbidity and mortality 2 , as well as reduce procedural... more dure can decrease the risks of patient's morbidity and mortality 2 , as well as reduce procedural costs 3. Conscious sedation during endoscopy has gained widespread diffusion and acceptance in the United States, however, in Asia sedation has a relative low
Backgrounds: 5% of gastrointestinal (GI) bleeding cannot be accurately detected by bi-directional... more Backgrounds: 5% of gastrointestinal (GI) bleeding cannot be accurately detected by bi-directional endoscopy. Wireless capsule endoscopy (CE) was introduced into medical diagnosis since 2000. This study is a multicenter experience of CE to detect the small intestinal diseases in Taiwan.Materials and Methods: The retrospective study was completed by questionnaires. 176 patients underwent wireless capsule endoscopy in eight medical centers in Taiwan. The indications of CE were obscure GI tract bleeding (n=137, 77.8%), anemia (n=18, 10.2%), abdominal pain (n=18, 10.2%), inflammatory bowel disease history (n=2, 1.1%), and gastric carcinoid history (n=1, 0.6%). The study by questionnaires analyzed the pathologic findings, total completion rate, complications of CE and outcomes of patients.Results: The examination completion rate of CE was 66.9% (115/172) and diagnostic yield rate was 90.1% (155/172). Angiodysplasia was the most diagnosed disease (47.7%, 82/172) and followed by small intestinal polyps, tumors or submucosa tumors (36%, 62/172), small intestinal ulcers or erosions (22.1%, 38/172), lymphangiectasia (14.0%, 24/172). 20 patients received surgical treatments (11 with angiodysplasia, 9 with polyps or tumors) and 18 patients received double-balloon enteroscopic examination after CE. Three capsules (1.74%) retained in small and large intestine more than two weeks and removed by surgical treatment.Conclusions: This multicenter cases analysis presented similar results as Western's reports. Wireless capsule endoscopy is a non-invasive, effect and safe examination and can be used as first line tool to diagnose small intestinal diseases.
Knowing when to give endoscopy to a primary dyspeptic patient is a difficult decision for any gas... more Knowing when to give endoscopy to a primary dyspeptic patient is a difficult decision for any gastroenterologist. We decided to address the problem by testing for Helicobacter pylon and analyzing patient's symptoms. Within one-year period, 117 consecutive dyspeptic outpatients underwent endoscopy. Of these patients, all had symptom duration longer than one month, had no sinister symptoms (anemia, body weight loss and gastrointestinal bleeding), never had previous endoscopy, had no gastric surgery, nor had ingestion of antibiotics or non-steroid anti-inflammatory drugs two weeks prior to enrollment, and were free of hepatobiliary disease by abdominal sonography. Urea breath test (UBT) with only a 15-minute collection interval was done to each patient and a questionnaire about dyspeptic symptoms was also answered. Patients were divided into three groups according to the results of UBT and endoscopy; UBT negative patients (n=44), UBT positive with no ulcer patients (n=37) and UBT positive with ulcer or scar present patients (n=36). In UBT negative patients, they were more younger and they had no evidence of peptic ulcer disease endoscopically. In UBT positive patients, patients with peptic ulcer disease had statistically signficant difference than those without peptic ulcer disease in that they had more regular attack of pain before meal and at midnight, and their pain can be relieved by eating. We conclude that the 15-minute UBT in association with symptoms analysis is helpful in deciding which dyspeptic patients need to be given endoscopy.
Background and Purpose: Mutations of the APC gene, a tumor suppressor gene, have been proposed to... more Background and Purpose: Mutations of the APC gene, a tumor suppressor gene, have been proposed to play critical roles in the development of colorectal cancer (CRC). Since many different types of APC gene mutations can occur and most of them are nonsense or frame-...
Alimentary Pharmacology & Therapeutics, Oct 10, 2018
Background: Mac-2 binding protein glycosylation isomer (M2BPGi) is an emerging biomarker for risk... more Background: Mac-2 binding protein glycosylation isomer (M2BPGi) is an emerging biomarker for risk prediction of liver disease, but data remain sparse for patients with chronic hepatitis B (CHB) who are treated with nucleos(t)ide analogues (NA). Aim: To clarify serial changes in M2BPGi and its association with subsequent hepatocellular carcinoma (HCC) development in NA-treated CHB patients. Methods: We enrolled 384 previously untreated CHB patients who received NAs. Among them, 195 had baseline cirrhosis (n = 142:48:5 for Child A:B:C). Sera were collected at NA initiation, and after 1 and 2 years. Serum M2BPGi levels were measured and expressed as cutoff index (COI) at different time points. The association between M2BPGi and HCC was evaluated by the Cox proportional hazard model. Results: The median M2BPGi levels significantly decreased from 1.68 COI at baseline, to 1.0 at year 1, and 0.88 at year 2. During median follow-up of 72.7 months, HCC occurred in 37 patients, 36 of whom had cirrhosis. In patients with cirrhosis, baseline M2BPGi level was associated with HCC risk (adjusted hazard ratio, 1.07 per COI; 95% CI, 1.01-1.14) on the multivariable Cox analysis, whereas levels at year 1 or 2 were not independently predictive. A risk score for HCC was developed using baseline M2BPGi, age and body mass index with c statistics of 0.77, 0.79 and 0.87 at 3, 5 and 10 years, respectively. Conclusions: Serum M2BPGi level significantly decreases after NA treatment in CHB patients. Baseline level can be factored into the risk prediction of HCC in NAtreated patients with cirrhosis.
Negative CLO test pellets can be reused repeatedly in diagnostic endoscopy within a short period ... more Negative CLO test pellets can be reused repeatedly in diagnostic endoscopy within a short period of time. However, the duration that these pellets can be stored at room temperature before second use remains unclear. A total of 360 patients, 190 males and 170 females, who required a CLO test during endoscopy, were enrolled in this study. Two biopsies were taken from the gastric antrum of each patient, one for testing with a new pellet and the other for testing with a reused pellet. The reused pellets were used randomly and were divided into five groups according to the time interval between their initial and second usages (1, 2, 3, 6, and > 6 mo). When a positive result was found, the time to color change was recorded. Good correlation was noted for nearly all the paired CLO tests in all groups with either both positive or both negative. Only four pairs produced discrepant results. There was no significant difference when the results of both new and reused CLO tests were compared using McNemar's test (p > 0.05). In positive pairs, there was no significant difference in the color change time of both tests in all five groups by two-tailed t-test (p > 0.05); Pearson's correlation and linear regression showed a strong correlation between the color time change in the five groups (p < 0.0001). Only 54 of the 427 negative pellets stored for more than 6 months could be reused because most were dried out or no longer yellow in color. In conclusion, negative CLO test pellets may be reused within 6 months after initial usage provided they are stored at room temperature.
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors arising from the wall of the GI tr... more Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors arising from the wall of the GI tract. They are most common in the stomach (about 70%), 20%~ 30% in the small intestine, and fewer than 10% in other locations of the GI tract [1]. Patients with a GIST ...
Background: Primary esophageal motility disorder, which can cause chest pain or dysphagia, is sel... more Background: Primary esophageal motility disorder, which can cause chest pain or dysphagia, is seldom reported in Chinese. With the introduction of an easy and less uncomfortable method to perform esophageal manometry by low-compliance perfusion system, we studied symptomatic patients for more than 10 years. These data were analyzed and were compared to Western reports. Methods: From August 1989 to June 1999, 264 patients with symptoms mimicking esophageal origin, such as chest pain, dysphagia or odynophagia, but without secondary motility disorders were enrolled. Esophageal manometry was performed on each patient. Results: Among 264 manometric tracings, 142 (54%) were normal and 122 (46%) were abnormal. In patients with abnormal tracings, 73 were nonspecific esophageal motility disorder (NEMD), 20 were achalasia, 9 were diffuse esophageal spasm (DES), 8 were nutcracker esophagus, 7 were hypotensive low esophageal sphincter (LES), 3 were abnormal provocative test by edrophonium, and 2 were hypertensive LES. As in Western countries, the most common abnormality was NEMD. However, our series did not find many patients with DES, nutcracker esophagus and hypertensive LES. Similar results were noted in patients with NEMD, that most had increased nontransmitted contractions and low contraction amplitude. Conclusions: We found that primary esophageal motility disorder is not uncommon in Taiwan. Esophageal manometry should always be considered in patients with symptoms mimicking esophageal origin.
Background: Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer d... more Background: Duodenal ulcer with deformity of the bulb is evidence of a chronic process of ulcer disease. This prospective study was carried out to investigate the relationship between the degree of bulbar deformity and the density of Helicobacter pylori infection in patients with duodenal ulcer. Methods: Patients with endoscopically proven active duodenal ulcers and a positive diagnosis of H. pylori infection were enrolled. Duodenal ulcers were divided into three types according to the degree of deformity of the bulb: type I, normal bulb; type II, mildly deformed; type III, markedly deformed. In each case, we evaluated the H. pylori density histologically. The density was graded according to the Sydney system (normal, mild, moderate, and marked). Results: A total of 95 duodenal ulcer patients were studied, including 25 with type I, 40 with type II, and 30 with type III duodenal ulcers. H. pylori density was correlated with deformity of the duodenal bulb: 16/25 (64%) patients with a type I ulcer had mild infection, 19/40 (47.5%) patients with a type II ulcer had moderate infection, and 15/30 (50%) patients with a type III ulcer had marked infection. Conclusion: Patients with active type II or III duodenal ulcers had greater densities of H. pylori than did those with type I ulcers. A tendency for higher H. pylori density was seen as the degree of deformity of the duodenal bulb increased.
Background and purpose: Many reports have confirmed that endoscopic ultrasonography (EUS) can dif... more Background and purpose: Many reports have confirmed that endoscopic ultrasonography (EUS) can differentiate gastric submucosal tumor from extragastric compression, but only a few specifically concentrated on EUS in identifying the causes of external compression. Materials and methods: From May 1993 to May 2001, we used EUS in 238 patients to diagnose gastric submucosal tumor or external compression. We excluded 183 patients who had submucosal tumors and analyzed the remaining 55 patients with extragastric compression. Malignant causes of external compression were proved by surgery or biopsy. Benign causes of external compression were proved by other imaging examinations (abdominal ultrasound, computerized tomography, angiography) or surgery. Patients with external compression caused by normal organs were followed up with repeated upper gastrointestinal endoscopy or EUS. Results: The stomach was compressed by normal extragastric organs in 32 patients (spleen 10, splenic vessel 6, gall bladder 9, liver 3, pancreas 3, and intestine 1), by benign pathologic lesions in 12 patients (liver cyst 7, liver hemagioma 2, splenic cyst 1, pancreatic cyst 1, pancreatic cystadenoma 1) and by malignant tumors in 5 patients (hepatoma 1, liver metastasis from colon cancer 2, pancreatic cystadenocarcinoma 1 and lymphoma of spleen 1). In the remaining six patients, neither submucosal tumor nor external compression was found during EUS examination and the external compression was considered transient. Conclusion: When an extragastric compression mimicking submucosal tumor is detected by upper gastrointestinal endoscopy, EUS is indicated to identify the cause of extragastric compression.
Colorectal cancer (CRC) is considered to develop slowly via a progressive accumulation of genetic... more Colorectal cancer (CRC) is considered to develop slowly via a progressive accumulation of genetic mutations. Markers of CRC may serve to provide the basis for decision-making, and may assist in cancer prevention, detection and prognostic prediction. DNA and messenger (m)RNA molecules that are present in human feces faithfully represent CRC manifestations. In the present study, exogenous mouse cells verified the feasibility of total fecal RNA as a marker of CRC. Furthermore, five significant genes encoding solute carrier family 15, member 4 (SLC15A4), cluster of differentiation (CD)44, 3-oxoacid CoA-transferase 1 (OXCT1), placenta-specific 8 (PLAC8) and growth arrest-specific 2 (GAS2), which are differentially expressed in the feces of CRC patients, were verified in different CRC cell lines using quantitative polymerase chain reaction. The present study demonstrated that the mRNA level of SLC15A4 was increased in the majority of CRC cell lines evaluated (SW1116, LS123, Caco-2 and T84). An increased level of CD44 mRNA was only detected in an early-stage CRC cell line, SW1116, whereas OXCT1 was expressed at higher levels in the metastatic CRC cell line CC-M3. In addition, two genes, PLAC8 and GAS2, were highly expressed in the recurrent CRC cell line SW620. Genes identified in the feces of CRC patients differed according to their clinical characteristics, and this differential expression was also detected in the corresponding CRC cell lines. In conclusion, feces represent a good marker of CRC and can be interpreted through the appropriate CRC cell lines.
Ascitic infection is a major cause of morbidity and mortality in liver cirrhosis patients. Many r... more Ascitic infection is a major cause of morbidity and mortality in liver cirrhosis patients. Many reports suggest that at least 5 days of third generation cephalosporin is better than a conventional first generation cephalosporin or amoxicillin plus an aminoglycoside for treating ascitic infections. We retrospectively reviewed 54 patients with culture-negative neutrocytic ascites (CNNA) or spontaneous bacterial peritonitis (SBP) who were treated with an intravenous first generation cephalosporin plus short-term gentamicin, or a second or third generation cephalosporin. Thirteen patients with CNNA (group A) were treated with an intravenous first generation cephalosporin plus short-term gentamicin intravenous drip (regimen Ⅰ). Another 18 CNNA patients (group B) were treated with an intravenous second or third generation cephalosporin monotherapy (regimen Ⅱ). Seven patients with SBP (group C) were treated with regimen Ⅰ and 16 patients with SBP (group D) were treated with regimen Ⅱ. Three and 16 patients with shock on admission were treated with regimen Ⅰ or Ⅱ respectively. We compared the success rates of these two regimens in CNNA and SBP groups. The successful treatment rates were 92.3% (12/13), 67.7% (12/18), 57.1% (4/7) and 37.5% (6/16) for groups A, B, C, D, respectively. The difference in success rates between regimen Ⅰ and regimen Ⅱ in the CNNA group or SBP group was not statistically significantly. However, the success rates for antibiotics given to non-septic shock patients and septic shock patients were significantly different (non-septic shock: 32/35 vs. septic shock: 2/19, p＜0.05,) A first generation cephalosporin plus short-term gentamicin has good effect to treat CNNA patients not in shock. But it should be used cautiously to prevent acute renal failure in cirrhosis patients. Broader spectrum antibiotics should be used in patients with shock or any clinical deterioration.
Unexplained chest pain nowadays has become the leading reason for patients being referred for eso... more Unexplained chest pain nowadays has become the leading reason for patients being referred for esophageal manometry. Some drugs are recently used as provocative agents to increase the diagnostic rate during this test and edrophonium chloride is the most common among them. Nevertheless, this provocative test has seldom been applied in Chinese patients. Therefore, we studied 158 consecutive patients with chest pain (group A) and 53 patients with other esophageal symptoms (group B) by using edrophonium as a provocative agent for inducing esophageal chest pain. Each of these patients received 80 μg/kg intravenous bolus dose of edrophonium preceded by saline infusions. Esophageal contractile pressures and contractile duration of upper middle and lower portions were measured before and after drug injection in response to ten 5 mL wet swallows. We found that chest pain was reproduced in only 8 patients and they were all in the group A. Besides, edrophonium increased esophageal pressure signficantly in all three monitored portions of esophageal body but increased contractile duration only in the middle and distal portions. We also found the adverse effects of this agent in such dose were mild and tolerable. In conclusion, edrophonium is relativly safe as a provocative agent and can diagnose chest pain of esophageal origin in small population of Chinese patients.
Objectives: Gastroesophageal flap valve (GEFV) can be divided into a four-grade system and this s... more Objectives: Gastroesophageal flap valve (GEFV) can be divided into a four-grade system and this system can well predict the prevalence of gastroesophageal reflux disease (GERD). We tried to use this GEFV grading system to examine the correlation of GEFV to erosive esophagitis. Methods: We enrolled 398 individuals that underwent one-day self-paid health examination, including esoph agogastroduodenoscopy (EGD) in 3-month period. GEFV grade I and Ⅱ were considered normal, whereas grade Ⅲ and Ⅳ were abnormal. We compared and analyzed the correlation of sex, body mass index (BMI) and GEFV grading with erosive esophagitis. Results: There were 37 subjects being diagnosed as abnormal gastroesophageal flap valve (37/398, 9.3%). 18 of them (18/37, 48.6%) had erosive esophagitis also. The remaining 361 subjects were diagnosed as normal flap valve (361/398, 90.7%) and 53 subjects were diagnosed as erosive esophagitis (53/361, 14.7%). Abnormal gastroesophageal flap valve subjects had higher chance to had erosive esophagitis (Odds Ratio=7.51, 95% CI=3.53-15.98). Males had higher prevalence of erosive esophagitis (Odds Ratio=3.74, 95% CI=1.90-7.38) and the prevalence of erosive esophagitis was 17.8%. Age and BMI did not increase the risk of esophagitis remarkably in the initial analyses (P=0.15 and 0.2) Conclusion: Male gender and subject, who have abnormal gastroesophageal flap valve, are prone to develop erosive esophagitis. Age and BMI do not increase the risk of esophagitis remarkably.
dure can decrease the risks of patient's morbidity and mortality 2 , as well as reduce procedural... more dure can decrease the risks of patient's morbidity and mortality 2 , as well as reduce procedural costs 3. Conscious sedation during endoscopy has gained widespread diffusion and acceptance in the United States, however, in Asia sedation has a relative low
Backgrounds: 5% of gastrointestinal (GI) bleeding cannot be accurately detected by bi-directional... more Backgrounds: 5% of gastrointestinal (GI) bleeding cannot be accurately detected by bi-directional endoscopy. Wireless capsule endoscopy (CE) was introduced into medical diagnosis since 2000. This study is a multicenter experience of CE to detect the small intestinal diseases in Taiwan.Materials and Methods: The retrospective study was completed by questionnaires. 176 patients underwent wireless capsule endoscopy in eight medical centers in Taiwan. The indications of CE were obscure GI tract bleeding (n=137, 77.8%), anemia (n=18, 10.2%), abdominal pain (n=18, 10.2%), inflammatory bowel disease history (n=2, 1.1%), and gastric carcinoid history (n=1, 0.6%). The study by questionnaires analyzed the pathologic findings, total completion rate, complications of CE and outcomes of patients.Results: The examination completion rate of CE was 66.9% (115/172) and diagnostic yield rate was 90.1% (155/172). Angiodysplasia was the most diagnosed disease (47.7%, 82/172) and followed by small intestinal polyps, tumors or submucosa tumors (36%, 62/172), small intestinal ulcers or erosions (22.1%, 38/172), lymphangiectasia (14.0%, 24/172). 20 patients received surgical treatments (11 with angiodysplasia, 9 with polyps or tumors) and 18 patients received double-balloon enteroscopic examination after CE. Three capsules (1.74%) retained in small and large intestine more than two weeks and removed by surgical treatment.Conclusions: This multicenter cases analysis presented similar results as Western's reports. Wireless capsule endoscopy is a non-invasive, effect and safe examination and can be used as first line tool to diagnose small intestinal diseases.
Knowing when to give endoscopy to a primary dyspeptic patient is a difficult decision for any gas... more Knowing when to give endoscopy to a primary dyspeptic patient is a difficult decision for any gastroenterologist. We decided to address the problem by testing for Helicobacter pylon and analyzing patient's symptoms. Within one-year period, 117 consecutive dyspeptic outpatients underwent endoscopy. Of these patients, all had symptom duration longer than one month, had no sinister symptoms (anemia, body weight loss and gastrointestinal bleeding), never had previous endoscopy, had no gastric surgery, nor had ingestion of antibiotics or non-steroid anti-inflammatory drugs two weeks prior to enrollment, and were free of hepatobiliary disease by abdominal sonography. Urea breath test (UBT) with only a 15-minute collection interval was done to each patient and a questionnaire about dyspeptic symptoms was also answered. Patients were divided into three groups according to the results of UBT and endoscopy; UBT negative patients (n=44), UBT positive with no ulcer patients (n=37) and UBT positive with ulcer or scar present patients (n=36). In UBT negative patients, they were more younger and they had no evidence of peptic ulcer disease endoscopically. In UBT positive patients, patients with peptic ulcer disease had statistically signficant difference than those without peptic ulcer disease in that they had more regular attack of pain before meal and at midnight, and their pain can be relieved by eating. We conclude that the 15-minute UBT in association with symptoms analysis is helpful in deciding which dyspeptic patients need to be given endoscopy.
Background and Purpose: Mutations of the APC gene, a tumor suppressor gene, have been proposed to... more Background and Purpose: Mutations of the APC gene, a tumor suppressor gene, have been proposed to play critical roles in the development of colorectal cancer (CRC). Since many different types of APC gene mutations can occur and most of them are nonsense or frame-...
Alimentary Pharmacology & Therapeutics, Oct 10, 2018
Background: Mac-2 binding protein glycosylation isomer (M2BPGi) is an emerging biomarker for risk... more Background: Mac-2 binding protein glycosylation isomer (M2BPGi) is an emerging biomarker for risk prediction of liver disease, but data remain sparse for patients with chronic hepatitis B (CHB) who are treated with nucleos(t)ide analogues (NA). Aim: To clarify serial changes in M2BPGi and its association with subsequent hepatocellular carcinoma (HCC) development in NA-treated CHB patients. Methods: We enrolled 384 previously untreated CHB patients who received NAs. Among them, 195 had baseline cirrhosis (n = 142:48:5 for Child A:B:C). Sera were collected at NA initiation, and after 1 and 2 years. Serum M2BPGi levels were measured and expressed as cutoff index (COI) at different time points. The association between M2BPGi and HCC was evaluated by the Cox proportional hazard model. Results: The median M2BPGi levels significantly decreased from 1.68 COI at baseline, to 1.0 at year 1, and 0.88 at year 2. During median follow-up of 72.7 months, HCC occurred in 37 patients, 36 of whom had cirrhosis. In patients with cirrhosis, baseline M2BPGi level was associated with HCC risk (adjusted hazard ratio, 1.07 per COI; 95% CI, 1.01-1.14) on the multivariable Cox analysis, whereas levels at year 1 or 2 were not independently predictive. A risk score for HCC was developed using baseline M2BPGi, age and body mass index with c statistics of 0.77, 0.79 and 0.87 at 3, 5 and 10 years, respectively. Conclusions: Serum M2BPGi level significantly decreases after NA treatment in CHB patients. Baseline level can be factored into the risk prediction of HCC in NAtreated patients with cirrhosis.
Uploads
Papers by Chia-Long Lee